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Eka Roina Megawati
Blood Pressure (BP)
O BP refers to arterial BP in systemic
O Systolic pressure; maximum BP occurs in
aorta during systolic ejection phase
O Diastolic pressure; minimum aortic pressure
is reached during isovolumic contraction
phase (while aortic valves are closed)
O Pulse pressure (PP) or blood pressure
amplitude is systolic – diastolic pressure
difference, and also is a function of stroke
volume (SV) and arterial compliance (C)
O When C decreases at constant SV, systolic
pressure will rise more sharply than diastolic
pressure (common in elderly)
O BP is routinely measured externally
(at the level of the heart) according to
the Riva-Rocci method by
O An inflatable cuff is snugly wrapped
around the arm and a stethoscope is
placed over the brachial artery at the
crook of the elbow.
O While reading the manometer, the
cuff is inflated to a pressure higher
than the expected Ps (the radial
pulse disappears). The air in the cuff
is then slowly released (2–4

Measurement of BP
O The first sounds synchronous
with the pulse (Korotkoff
sounds) indicate that the cuff
pressure has fallen below the
O This value is read from the
O These sounds first become
increasingly louder, then more
quiet and muffled and
eventually disappear when the
cuff pressure falls below the
Pd (second reading).
Mean Arterial Pressure = MAP
O MAP is average pressure driving blood
forward into tissues throughout cardiac
cycle, the main driving force for propelling
blood to tissues.
O MAP = Diastolic pressure + 1/3 pulse
O Central Venous Pressure is the pressure in
the right atrium = Right Arterial Pressure
(RAP) because all systemic veins flow into
the right atrium
Central Venous Pressure =
Right Atrial Pressure (RAP)
O RAP is regulated by a balance between:
O (1) ability of the heart to pump blood out of the
right atrium and ventricle into the lungs
O (2) the tendency for blood to flow from the
peripheral veins into the right atrium
O  if the right heart is pumping strongly, the right
atrial pressure decreases, conversely weakness
of the heart elevates right atrial pressure
O Normal right atrial pressure is 0 mmHg which is
equal to the atmospheric pressure around th
O Baroreceptors are pressure
sensors that constantly
monitors mean arterial
pressure within the circulatory

• When deviations from normal are detected,

multiple reflex are initiated to return mean
arterial pressure to its normal value

O Short-term (within seconds) adjustments are
made by alterations in cardiac output and total
peripheral resistance, mediated by means of
autonomic nervous system influences on the
heart, veins, and arterioles.
O Long-term (requiring minutes to days) control
involves adjusting total blood volume by
restoring normal salt and water balance through
mechanisms that regulate urine output and
O Guyton CA and Hall JE, Textbook of Medical
Physiology, Eleventh edition
O Sherwood L, Fundamentals of Physiology, a
Human Perspective, Third edition
O Despopoulus A and Silbernagl S, Color atlas
of Physiology, Third edition